tortu

Hello, i am a 30 years old boy portugueses (sorry for my english) and in 11th may i had sex with a boy. To explain better, i am going befor that day. At the beginnnig of this year i had fungus / mycosis on my groins and scrotum, did treatemet but it has never been totally good since then. From the last 2 weeks i am doing topic corticosteroids on the skin on those áreas and oral intraconazol. In the last 48h i had sex with that guy, we did both oral sex without condom and i inserted my pénis inside him (he didnt do that to me). I inserted my pénis 4 times without condom but for a few seconds in every time. (remeber i have my skin of my pénis scrotum and groin a little with inflamation). After that i put a condom and we did everything until the end with protection. Imediately after the sex i see my pénis, groins, and scrotum more red than usually. After that he tells me he is hiv+ undetectable. He show me his analysis (hiv 1 viral <50.000) and herpes and syphilis both IgM + in 2th january. He said he did tretament and last time doctor said he was undetectable was on 2th january. My question: which is my risk in this situation? And when should i get tested? Thank u very very much!

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helpline-volunteer

Hello,


Thank you for your inquiry. From what we gather from the question, you were asking about the risk of acquiring HIV after engaging in unprotected insertive sex. From the information given, this scenario is determined to be High Risk (there is evidence of transmission through these activities and are the majority of cases of transmission). 


The scenario mentioned above
does meet the three components of the transmission equation. It is important to note that if any unprotected intercourse occurred, then the scenario is determined to be high risk, regardless of the time of the exposure or the HIV status of the person involved in the activity.Helpline Transmission Equation .jpgAfter engaging in a high risk activity it is recommended to access HIV testing. An HIV test that detects antibodies to the HIV virus (3rd Generation Tests) or an HIV test that detects both HIV antibodies as well as the HIV virus (4th Generation Tests) are considered completely conclusive 3 months post-exposure (1). If you would like to access earlier testing, a 4th generation test conducted 6 weeks post-exposure is considered conclusive by most HIV specialists, with a follow-up test at 3 months post-exposure to fulfill guidelines for completely conclusive results. During the window period between a risky activity and accessing an accurate HIV test, it is important to not engage in further risky activity.

Having open communication with your partner is a great way to take care of your sexual health. A person living with HIV who has an undetectable viral load is not able to transmit HIV through sexual intercourse, thus it is very unlikely that HIV transmission occurred in this scenario (2). Please note that it is still highly recommended to access HIV testing as well as other STI testing after engaging in risky activities with another person, regardless of who they are or their HIV status.

In the future, if you are continuously engaging in high risk activity, there are biomedical approaches such as PrEP and PEP (accessed within 72 hours of the activity) that help lower your risk of acquiring HIV. Refer to your physicians for further information.

Recommendation: Refer to a health care provider for HIV testing outside of the HIV window period.

Regards,

AIDS Vancouver Helpline/Online, Marie
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1) HIV Testing Technologies
2) PARTNER Studies
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danagbham
Hello,
I am a 49 year old who has been living with HIV for the past few years. Last year I started a casual sexual relationship with a young man in which we practiced safe sex; condoms with no oral sex. Over time, our interactions became more frequent. At a point he tried to engage in unprotected sex at which time I informed him of my status and let him know that I was undetectable as of Feb this year. Having spent several overnight stays at my house, I noticed that he was experiencing night sweats frequently, so I insisted that he get STI tests done. He did have antibody test done and came back negative for HIV and other STI's. At the same time, he had developed what appeared to be fever blisters on his mouth, which; combined with the night sweat did cause me some concern, so I also had STI panel and viral load analysis done, since we had engaged in unprotected sex a couple time while these blisters were present. I was informed a day later that I was positive for HSV 2. I informed him, since I had not tested positive for this before and we discovered that the clinic where he got his test done, did not check for HSV. Although I had an undetectable viral load as of Feb., I still decided to have my viral load analyzed again this month for reassurance. It came back undetectable still. I would like to know the likelihood of having passed HIV to him with a recently undiagnosed HSV infection and him probably having had a long term undiagnosed HSV 2 infection during those unprotected encounters during what appeared to be his outbreak.   
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helpline-volunteer
Hi there,

Thank you for your inquiry. From what we gather from the question, you were asking about the possibility of HIV transmission to your partner which you have described you have had engaged in unprotected sex several times. At this time, you were adhering to your ART, rendering your viral load undetectable, (as proven by your viral load analysis results). More specifically, we understand your question is regarding your recent diagnosis of HSV 2, and the likelihood that your partner's symptoms may be attributed to the onset of HIV seroconversion.

In regard to your HSV 2 diagnosis, it has been proven that visible lesions caused by HSV are spread through skin-to-skin contact (1) During sexual activity, one with open or bleeding sores may be more susceptible to HIV transmission (1). In the right circumstance, bleeding sores may provide HIV positive fluid with direct access to the bloodstream. 

However, as you maintain, your current HIV status is undetectable. Several HIV partner studies have proven that undetectable=untransmittable, including the Partner 2 study, which demonstrated that there had been no cases of HIV transmission between HIV-discordant MSM partners among 77,000 condomless sexual acts, while the partner living with HIV had achieved viral suppression, and the partner not living with HIV was not on PrEP (Pre-Exposure Prophylaxis), or PEP (Post-Exposure Prophylaxis) (2). 

You mention that your partner had received testing, and had received a non-reactive result for HIV and other STI's. It is nearly impossible to diagnose HIV by analyzing one's physical symptoms, as symptoms tend to present differently from patient to patient. For this reason, an HIV diagnosis can only be proven through adequate testing confirmation.

You may suggest to your partner that they continue to seek regular HIV testing confirmation, as you move forward. Your status as undetectable through regular ART adherence may prove to be extremely effective in preventing HIV transmission from occurring. If you are worried about HIV transmission and would like to continue protecting your partner (without using a condom during intercourse), there are other biomedical options you may explore (ie. PrEP & PEP). 

In summary, your HSV diagnosis may have caused additional risk for your partner, in the event you were not undetectable. However, because you are and continue to be diligent with your medication, your partner is at no additional risk. Symptoms may be due to another illness, and cannot be attributed to HIV seroconversion without a positive diagnosis. 

Recommendation: Please continue to adhere to ART, and ensure your partner is receiving regular HIV testing moving forward. Explore options regarding PrEP & PEP. 

All the best, 

AIDS Vancouver Online/Helpline, Cody 

HSV and HIV (1)
U=U (2)

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